A comparison of traditional anterior colporrhaphy, polypropylene mesh and porcine dermis in cystocele repair.

484 | October-December 2007 | time emphasizing the need for a longer study period. The higher success rates in the sling group were partly offset by a higher number of urinary tract infections, urge incontinence, voiding dysfunction and a greater number of reoperations to improve voiding. An important fact highlighted by the editorial[7] on this article was that if success rates were measured based purely on the satisfaction of the women, success rates would be even lower. To a surgeon, an occasional leak may be acceptable but to a woman who works in a busy corporate office or is a college lecturer it may be a social embarrassment. Also, the benefit of these procedures is partly offset by the onset of symptoms of urgency and urge incontinence. Similar to autologous fascial sling, TVT when compared to Burch colposuspension was found to have better results.[8] In conclusion, this is a well-conducted clinical trial with adequate sample size to compare two established operative procedures. The autologous fascial sling has a better outcome in terms of cure rates. Erosion of slings, which is more relevant to synthetic slings, is one aspect that has not been studied. This study will be helpful in counseling patients as to a procedure for stress incontinence. However, trials with a longer follow-up and addressing patient satisfaction primarily will be more useful to assess the impact on the patient’s quality of life. ReFeRenCeS

time emphasizing the need for a longer study period. The higher success rates in the sling group were partly offset by a higher number of urinary tract infections, urge incontinence, voiding dysfunction and a greater number of reoperations to improve voiding. An important fact highlighted by the editorial [7] on this article was that if success rates were measured based purely on the satisfaction of the women, success rates would be even lower. To a surgeon, an occasional leak may be acceptable but to a woman who works in a busy corporate office or is a college lecturer it may be a social embarrassment. Also, the benefit of these procedures is partly offset by the onset of symptoms of urgency and urge incontinence. Similar to autologous fascial sling, TVT when compared to Burch colposuspension was found to have better results. [8] In conclusion, this is a well-conducted clinical trial with adequate sample size to compare two established operative procedures. The autologous fascial sling has a better outcome in terms of cure rates. Erosion of slings, which is more relevant to synthetic slings, is one aspect that has not been studied. This study will be helpful in counseling patients as to a procedure for stress incontinence. However, trials with a longer follow-up and addressing patient satisfaction primarily will be more useful to assess the impact on the patient's quality of life.

SummARy
This is a retrospective review of 119 patients who underwent cystocele repair by the same urologist using porcine dermal graft, polypropylene mesh or traditional repair from January 1999 to August 2005. Average follow-up of 13.5 months (range two to 46) was available for 99 patients. Fifty-six (57%) underwent cystocele repair using porcine dermal graft, 25 (25%) received polypropylene mesh and 18 (18%) underwent traditional repair. Twenty-two (22%) patients had cystocele recurrence. Thirty-six per cent patients (20 of 56) with porcine dermal grafts had recurrence compared to 4% (one of 25) and 6% (one of 18) using polypropylene and traditional repair, respectively. Mean time to cystocele recurrence was 4.9 months (range 0.5 to 20). Twelve patients (21%) had extrusion of porcine grafts through the anterior vaginal wall incision compared to one (4%) with polypropylene mesh. Short-term failure rate for anterior vaginal wall prolapse using porcine dermis interposition graft was higher than that for traditional anterior colporrhaphy or polypropylene mesh. In addition, the incidence of vaginal extrusion of porcine graft was unacceptably high. Porcine dermis is a less suitable material for cystocele repair than polypropylene mesh or traditional anterior colporrhaphy. | October-December 2007 |

CommenTS
Recurrent anterior vaginal wall prolapse can develop in more than 20% of patients undergoing traditional anterior colporrhaphy. In light of this high recurrence rate many surgeons have been incorporating synthetic or allograft mesh to augment the repair.
In this study there are some shortcomings, including retrospective design, short follow-up for a study spanning almost six years and a lack of validated questionnaires. Authors report a negative experience with porcine dermis, both in terms of success and extrusion rate. However, others have reported better outcome [1] which may be due to different follow-up times and outcome measures. Apart from this, biological grafts are also associated with allergic reactions and disease transmission. There is paucity of data regarding prospective randomized trials on the use of these biomaterials prior to their widespread human need which might help in reducing such type of experiences. Unless such data are available surgeons should give serious thought prior to embarking on the use of such biological materials. [2] Is there a better indicator for predicting the outcome of trial without catheter?

SummARy
This prospective clinical study was done to assess the impact of intravesical prostatic protrusion (IPP) on the outcome of trial without catheter (TWOC) following acute urinary retention (AUR). Consecutive white men aged 50 years or older with AUR related to benign prostatic hyperplasia (BPH) were recruited for the study. The mean age of these men was 70.1 years. Men with neurological illness, prostatic carcinoma, abnormal renal function, urethral stricture, residual urine > 1500 ml, prostatic or urethral surgery, being treated with anticholinergics and with severe comorbid illness were excluded. All were given 10 mg of Alfusozin daily after catheterization along with treatment of precipitating factors. TWOC was given after two weeks. The prostatic volume was measured with transrectal ultrasound of the prostate (TRUS) immediately after catheter removal. The mean prostatic volume (PV) of this cohort was large (68.3 ml) and their mean IPP was 12.4 mm. Fifty-seven out of 121 men with AUR fulfilled the selection criteria. Of these 57, 18 and 39 had precipitated and spontaneous AUR respectively. A strong correlation was noted between successful TWOC and prostatic volume and IPP. Twentyfive out of 57 (43.9%) had successful TWOC (8/18 in the precipitated group and 17/39 in the spontaneous group). Men with successful TWOC had smaller mean PV (55 vs 70 ml) and smaller mean IPP (7.2 mm vs 16.5 mm). No association was found between age, retention volume, mode of retention (spontaneous or precipitated) and successful TWOC. Men with PV ≥ 50 ml had a three fold risk of unsuccessful TWOC compared to those with PV < 50 ml (P < 0.002). From Receiver Operating Characteristics (ROC) curve analysis, IPP was more accurate than PV in predicting successful TWOC. Of the men with IPP ≤ 10 mm, 78% had successful TWOC compared with 13% success in those with IPP > 10 mm (P < 0.0001).

CommenTS
Trial without catheter after a short course of α-blockers is often adopted by many urologists for AUR. The predictors for a successful outcome following TWOC are residual urine < 500 ml, gland size < 50 ml, men younger than 65 years, TWOC after prolonged catheterization, lower